Prevalensi dan faktor penentu prediabetes pada wanita muda obesitas di Kota Denpasar tahun 2019

Background: The prevalence of prediabetic state in population is such a hard project to be confirmed within an increased number of obese population.

Aim: The study aims to define the prevalence of prediabetes among obese young women (body mass index, BMI >25 kg/m²) in Denpasar.

Methods: Research variables namely physical activity, food pattern, anthropometric values for identify level of obesity (light BMI 25-30, severe BMI >30 kg/m²), tipe of obesity (perifer obesity waist circumference <80 cm,  and central obesity waist circumference ≥80 cm), as well as fasting blood glucose (normal <100 mg/dL, prediabetes -125 mg/dL).

Results: the prediabetes prevalence of subjects is 38,1%. All subjects 42 (100%) have light daily physical activity, with high mean of cholesterol intake (more than 200mg) and low of PUFA intake (less than 10% of fat intake). Pre-diabetic subjects have higher waist circumference (visceral fat) than subjects with normal blood glucose (p=0.023). In contrary, that was no relationship between subcutaneous fat (bicep and tricep skinfold) to prediabetic state(p >0,05). Central obesity was significant OR 1,76 (1,33-2,33) risk of prediabetes compared to peripheral obesity (p= 0,023). However, there was not significant risk (OR 2,67 (0,738-9,63) (p= 0,130)) of severe obesity to be prediabetes compared to light obesity.

 

Latar Belakang: Peningkatan prevalensi obesitas bersamaan dengan prevalensi diabetes melitus tipe 2. Prevalensi prediabetes sangat susah dideteksi pada suatu populasi.

Tujuan: untuk mengetahui prevalensi dan faktor penentu prediabetes pada wanita muda obese (indeks massa tubuh, IMT >25) di Denpasar.

Metode: Penelitian ini termasuk studi cross-sectional dengan variabel penelitian, meliputi aktivitas fisik, pola makan, antropometri pada tingkat obesitas (obesitas ringan IMT 25-30 kg/m², obesitas berat IMT>30 kg/m²) dan jenis obesitas (obesitas perifer lingkar perut <80 cm, obesitas sentral lingkar perut >80 cm), serta kadar glukosa darah puasa (normal <100 mg/dL, prediabetes -125 mg/dL).

Hasil dan Simpulan: prevalensi prediabetes dari subjek adalah 38,1%. Semua subjek 42 (100%) memiliki aktivitas fisik harian yang ringan, dengan rata-rata asupan kolesterol yang tinggi (>200mg) dan asupan PUFA (pure unsaturated fatty-acid) yang rendah (<10% dari asupan lemak). Subjek dengan prediabetes mempunyai lingkar perut (lemak visceral) lebih besar dibandingkan dengan subjek dengan kadar gua darah normal (p=0,023). Sebaliknya, tidak didapat hubungan antara lemak subkutan (lipatan kulit bisep dan trisep) dengan kejadian prediabetes (p>0,05). Obesitas sentral bermakna berisiko menderita prediabetes OR 1,76 (1,33-2,33) dibandingkan dengan obesitas perifer (p= 0,023). Namun, tidak ada risiko yang signifikan [OR 2,67; (0,738-9,63) (p= 0,130)] obesitas berat menjadi prediabetes dibandingkan dengan obesitas ringan.

 

Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients

Introduction: The mortality of severe traumatic brain injury (TBI) is contributed by the severity of the head injury, associated trauma, and complication during treatment. This study aimed to develop a prognostic scoring system of risk factors that contribute to the 14-day mortality of severe TBI.

Methods: This was a prospective cohort study including 105 severe TBI patients recruited consecutively from March to October 2016. Multivariate analysis with logistic regression was performed to determine the most contributing risk factors. The validation of prognostic factor was performed with ROC, sensitivity and specificity analysis.

Result: There were five significant risk factors of 14-day mortality, which were age > 60 years old (RR: 15.6, 95% CI: 1.88 – 129.95), hypoxia (RR: 17.78, 95% CI: 2.05 – 154.11), GCS 3 – 5 (RR: 34.71, 95% CI: 6.85 – 175.98), effacement of basal cistern (RR: 12.71, 95% CI: 2.61 – 61.95), and traumatic subarachnoid hemorrhage (tSAH) (RR:7.57, 95% CI: 1.19 – 48.36). The prognostic score ranged from 0 to 6 with the best cut-off point of 1. The best predictive AUC with ROC analysis was 0.817, 81.2% of sensitivity, and 75.0% of specificity.

The role of mean platelet volume (MPV) level as an independent predictor for varicocele in late adolescent

Background: Recent studies have reported significant associations between varicocele and platelet volume indices (PVIs). PVIs are inexpensive and widely used indicators consisting of mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) and are related to platelet volume and function. The possibility of PVIs as a predictor for varicocele is yet to be exposed. This study aimed to assess the role of PVIs as a predictor for varicocele in the late adolescent.

Methods: This retrospective case-control study involved 89 varicocele subjects (group I) and 89 healthy controls (group II) of similar age, stature, and body mass index. The data were consecutively taken from medical records at Bhayangkara Denpasar Hospital between January 2017 and May 2019. The diagnosis of varicocele was based on the findings from both physical examination and color doppler ultrasound (CDU). PVIs indicators were analyzed among the two groups. Statistical analysis was performed using receiver operating characteristic (ROC) curve to determine optimum cut-offs, bivariate chi-square test, and multivariate analysis using binary logistic regression, with p<0.05 considered statistically significant.

Results: ROC curve analysis showed optimum cut-offs of 8.05, 12.05, and 15.1 for MPV, PDW and P-LCR respectively (Youden index: 0.494, 0.326, 0.292; p < 0.001, p <0.001, p=0.001 respectively). Chi-square test showed significant associations between the PVIs indicators and varicocele (p < 0.001). Binary logistic regression analysis revealed that MPV level of ≥ 8.05 is an independent predictor for late adolescent varicocele (OR=6.001; 95%CI 2.547-14.139; p < 0.001).

Conclusion: MPV can be used as an independent predictor for assessing varicocele in the late adolescent.

Faktor – faktor yang berhubungan dengan luaran klinis pasien tetanus di RSUP Sanglah pada bulan Januari 2018 – Oktober 2019

Introduction: Tetanuseis anwacute diseasedthat attacks thewperipheral nervousgsystem, causedebyfthe tetanospamin toxinvproducedbbymthe bacterium Clostridiumbtetani. Tetanusfcan be lifecthreatening andgis stillra healthgproblem forxdevelopingvcountries, includingvIndonesia. Thisfstudy aimsbto determinekthe characteristicskand relationships of age, incubation period, tetanus degree, and complications of the clinical outcome of tetanus patients in Sanglah Hospital Denpasar in January 2018 - October22019.

Method: Thissstudy is accross-sectionall studyeof 333samples thatfwere takenxfrom secondaryddata infthe formvof medicalbrecords atvSanglah HospitalcDenpasar.rDatalwerekanalyzeduusing SPSS software version 23.

Result: Tetanusfpatients with age <60 years found in 19 people, >60 years found in 14 people. The incubation period <7 days was found in 7 people, >7 days was found in 26 people. TetanussAblett I / mild scores was found in 1 person, II/moderate in 18 people, III/severe in 9 people, IV/very severe in 5 people. Cardiovascular complications was found in 16 people, respiratory system in 11 people, no complications in 6 people. Good clinical outcomes (survive) in 19 people, death in 14 people.

Conclusion: There is no relationship between age and incubation period on clinical outcomes Theregis afstrong relationshiptbetween thebdegree of tetanusvand complicationsvwith clinicalboutcomes with significantgvalues respectively of p=0.008i (correlationbcoefficient = 0.443) and p=0.004 (correlationfcoefficient = 0.487).

Latar Belakang: Tetanusrrmerupakant tpenyakit akutr yangr menyerangr susunany sarafhtepi, disebabkanlloleh toxin tetanospamin yangfdihasilkan oleh bakteri Clostridiummtetani. Penyakitrtetanus dapatbmengancam nyawabdan masihbmerupakan masalahxkesehatan bagiz negara-negara berkembang, termasukkkIndonesia. Penelitiannnini bertujuanf funtuktt mengetahui karakteristike dan hubunganefaktorrusia, masa inkubasi, derajat tetanus, dan komplikasi terhadap luaran klinis pasien tetanus di RSUP Sanglah Denpasar pada bulan januari 2018 – Oktoberr2019.

Metode: Penelitiangini merupakanvpenelitian potongslintang pada233 sampeltyang diambilhdari datacsekunder berupazrekam medisddi RSUPCSanglahcDenpasar.wData dianalisisjmenggunakanrsoftware SPSSsversi 23.

Hasil: Pasien tetanus dengan usia < 60 tahun dijumpai 19 orang, > 60 tahun sebanyak 14 orang. Masa inkubasi < 7 hari dijumpai pada 7 orang, > 7 hari dijumpai pada 26 orang. Tetanus skoreAblett I/ringan dijumpai 1 orang, II/sedang sebanyak 18 orang, III/berat sebanyak 9 orang, IV/sangat berat sebanyak 5 orang. Komplikasi kardiovaskular dijumpai 16 orang, sistem pernafasan 11 orang, tidak ada komplikasi pada 6 orang. Luaran klinis yang bertahan hidup = 19 orang, meninggal = 14 orang.

Simpulan: Tidak terdapat hubungan antara faktor usia dan masa inkubasi terhadap luaran klinis. Terdapat hubungan yang kuat antara derajat tetanus dan komplikasi dengan luaran klinis dengan nilai signifikan berturut-turut sebesar p=0,008 (koefisienckorelasi 0,443) dan p=0,004 (koefisientkorelasi 0,487).

Association between age, urine pH, and urinary stone incidence in Kardinah Tegal General Hospital, Indonesia

Introduction: An increase in the incidence of urolithiasis at age> 15 years in Indonesia provides increased morbidity and medical costs. The study aims to determine the association between age, urine pH, and urinary stones incidence in Kardinah Tegal General Hospital, Indonesia.

Method: There were 240 subjects from July to August 2019, with urolithiasis in Kardinah Tegal General Hospital who never received any previous treatment for urolithiasis. Subjects were divided into 120 subjects in case group and 120 subjects in control group. Medical records were assessed and reviewed for age, gender, urinalysis (including urine pH), urinary tract infection (UTI), and urinary stones incidence. Kolmogorov-Smirnov was used to assess data distribution of age and urine pH, and Chi-square test was used to evaluate the association between each age category and urinary pH.

Results: Subject’s mean age between urolithiasis and non-urolithiasis groups were 47.68 ± 11.74 and 55.49 ± 15.72 years old, respectively There are no significant differences in stone incidence according to urinary pH in both groups. Stone incidence was found to be highest in age group of 50-59 years old in acidic urinary pH. No age group and urinary pH were associated with stone incidence. The odds of urinary stones occurrence would be 0.689 times more likely to happen with the increase of urinary pH,

Hubungan asupan gula sederhana terhadap kadar glukosa darah pada pasien diabetes mellitus tipe II

Background: Type II DM is associated with lifestyle that cause obesity. Obesity is caused by excessive intake of simple sugars that cause insulin resistance.

Aim: The study aims to determine the relationship between intake of simple sugars, carbohydrates, and calories with blood glucose levels in type II DM patients.

Methods: This study was an observational analytic design, at the Western Denpasar Health Center I and II in August to September 2019. The inclusion criteria were type II DM patients without using insulin, normal BMI, and willing to participate. Exclusion criteria were type II DM patients who on diet (no carbohydrate). The number of samples was 100 people with simple random sampling technique. The procedure was started by giving informed consent, checking BMI, filling of 2x24 hour food recall, and checking blood glucose using glucometer.

Results: Calorie for men was 1059.61 kcal and women was 1081.65 kcal. Carbohydrate intake in men was 149.15 grams and in women was 157.26 grams. Simple sugar intake in men is 24.98 grams and in women is 28.41 grams. There is a relationship between intake of simple sugars, carbohydrate, and calories with blood glucose levels (p = 0,000; p = 0.001; p = 0.024) and correlation strength (r = 0.44; r = 0.32; r = 0.23).

Conclusion: There is a moderate correlation between simple sugar intake and carbohydrate intake with blood glucose levels and a weak correlation between calorie intake and blood glucose levels.

Latar Belakang: DM tipe II berhubungan dengan gaya hidup, salah satunya adalah obesitas. Obesitas ini disebabkan oleh asupan gula sederhana yang berlebih yang menyebabkan resistensi insulin. Tujuan: Untuk mengetahui hubungan antara asupan gula sederhana, karbohidrat, dan kalori dengan kadar glukosa dalam darah pada pasien DM tipe II.

Metode: Penelitian ini menggunakan desain observasional analitik yang dilakukan di Puskesmas Denpasar Barat I dan Puskesmas Denpasar Barat II pada Agustus hingga September 2019. Kriteria inklusi adalah pasien DM tipe II tanpa menggunakan insulin, indeks massa tubuh normal, dan bersedia untuk mengikuti penelitian. Kriteria eksklusi adalah pasien DM tipe II yang melakukan diet tanpa mengonsumsi karbohidrat. Jumlah sampel sebesar 100 orang dengan teknik simple random sampling. Prosedur penelitian diawali dengan pemberian informed consent, pengecekan indeks massa tubuh, pengisian data food recall 2x24 jam, dan pengecekan glukosa darah sewaktu dengan glukometer. Analisis data adalah uji univariat dengan Uji Kolmogorov Smirnov dan uji bivariat dengan Uji Spearman.

Hasil: Asupan kalori per hari pada laki-laki sebesar 1059,61 kkal dan perempuan sebesar 1081,65 kkal. Asupan karbohidrat pada laki-laki sebesar 149,15 gram dan pada perempuan sebesar 157,26 gram. Asupan gula sederhana pada laki-laki sebesar 24,98 gram dan pada perempuan sebesar 28,41 gram. Analisis menunjukkan adanya hubungan antara asupan gula sederhana, karbohidrat, dan kalori dengan kadar glukosa darah (p=0,000; p=0,001; p=0,024) dan kekuatan korelasi (r=0,44; r=0,32; r=0,23).

Simpulan: Terdapat korelasi sedang antara asupan gula sederhana dan asupan karbohidrat dengan kadar glukosa darah dan korelasi lemah antara asupan kalori dengan kadar glukosa darah.

Depression among first-year medical students in Universitas Udayana in 2016

Background: Depression is categorized as a mood disorder which causes changes in a person’s activity as well as life perception and could even cause suicides. Medical students are more distressed than the general population.

Aim: This research was conducted to determine the degree of depression among 1^st year medical students of Universitas Udayana.

Method: This is research is using based on descriptive cross sectional study in order to obtain data about the amount of knowledge students about depression in Udayana University from November 2015 – January 2016. 100 sample sizes are needed for this study. The Beck’s Depression Inventory (BDI) questionnaire is also used in this study.

Results: Most of the students in the Medical Faculty of Udayana University have a relatively normal feeling of good and bad that happens in life. A smaller number of students have shown to have mild mood disturbances and but does not indicate the presence depression. The majority of students who suffered from depression are 17 years old based on the BDI scoring, which consisted of 4 students.

Conclusion: There female students, they who were living alone, and they who were unable to sleep normally, had the higher prevalence of suffering depression.

Faktor risiko untuk fungsi hip yang buruk pada pasien dengan patah tulang kolum femur pasca hemiarthroplasti bipolar tiga bulan pasca operasi

Introduction. As one of the frequent problems globally, fractures of the column femur may cause morbidity and mortality if not well-treated. The most common treatment for hip fracture is bipolar hemiarthroplasty. Hemiarthroplasty generally has good results, but with increasing patient age, implant function deteriorates. Through this research, the authors were interested in investigating the factors that may contribute to the functional outcome of bipolar hemiarthroplasty procedure, including Leg Length Discrepancy (LLD), osteoporosis, the diameter of the femoral head, stem malposition, and implant loosening.

Methods. This is a case-control study. The case group was patients with Harris Hip Score (HHS) < 70 (poor hip function), while the control group was patients with HHS > 70. X-ray examination was performed to evaluate for the LLD, stem malposition, osteoporosis, femoral head diameter, and implant loosening three months after surgery. The result was tabulated in 2x2 tables, then descriptive and inferential analysis was conducted.

Results. Chi-square tests for LLD, osteoporosis and femoral head diameter yielded p = 0.012, p = 0.026, and p = 0.002 respectively, showing significant differences in HHS at three months after bipolar hemiarthroplasty surgery (p <0.05). While the chi-square test for implant loosening and stem malposition resulted in p = 0.469 and p = 0.115, neither of these showed significant differences between groups (p> 0.05).

Conclusion. Differences in leg length (LLD), osteoporosis, and diameter of the femoral head were risk factors for the poor functional outcome (HHS <70) at three months after surgery in patients who underwent bipolar hemiarthroplasty due to fracture of the femoral column. Meanwhile, the stem malposition and loosening of the implant have not been shown any association with HHS <70.

Pendahuluan. Sebagai salah satu masalah yang sering terjadi secara global, patah tulang kolum femur dapat menyebabkan morbiditas dan mortalitas jika tidak diobati dengan baik. Pengobatan yang paling umum untuk patah tulang panggul adalah hemiarthroplasti bipolar (bipolar hemiarthroplasty). Hemiarthroplasti umumnya memiliki hasil yang baik, tetapi dengan bertambahnya usia pasien, fungsi implan memburuk. Melalui penelitian ini, penulis tertarik untuk menyelidiki berbagai faktor yang dapat berkontribusi terhadap hasil fungsional setelah prosedur hemiarthroplasti bipolar, termasuk perbedaan panjang tungkai (leg length discrepancy / LLD), osteoporosis, besar diameter kepala femur, malposisi stem, dan pelonggaran implan.

Metode. Studi menggunakan desain kasus-kontrol. Kelompok kasus adalah pasien dengan Harris Hip Score (HHS) < 70 (luaran fungsional buruk), sedangkan kelompok kontrol adalah pasien dengan HHS > 70. Pemeriksaan foto polos dilakukan untuk melihat LLD, malposisi stem, osteoporosis, diameter kepala femur, dan pelonggaran implan. Data disusun dalam bentuk tabulasi silang kemudian analisis deskriptif dan inferensial.

Hasil. Uji chi-square untuk LLD, osteoporosis dan diameter kepala femur menghasilkan nilai p = 0,012, p = 0,026, dan p = 0,002 berturut-turut, menunjukkan perbedaan yang bermakna dalam hal HHS pada tiga bulan pasca operasi pada pasien dengan fraktur kolum femur setelah hemiarthroplasti bipolar (p < 0,05). Sementara uji chi-square untuk pelonggaran dari implan dan malposisi stem menghasilkan nilai p = 0,469 dan p = 0,115, keduanya tidak menunjukan perbedaan bermakna antar kelompok (p > 0,05).

Simpulan. Perbedaan panjang tungkai (LLD), osteoporosis, dan besar diameter kepala dari tulang femur merupakan faktor risiko untuk luaran fungsional yang buruk (HHS < 70) setelah hemiarthroplasti bipolar setidaknya tiga bulan setelah pembedahan pada pasien dengan fraktur kolum dari tulang femur. Faktor malposisi stem dan pelonggaran dari implant belum terbukti menjadi faktor risiko.

Mobile Voluntary Counseling Testing (VCT) pada Perkumpulan Keluarga Berencana Indonesia (PKBI) Daerah Bali: studi empiris dalam upaya penanganan HIV-AIDS

Background: Nowadays, the transmission of HIV-AIDS is mostly due to risky sexual activity and found in the heterosexual group, around 76.5%. The high rate may be due to stigma and discrimination in society, so risk people are reluctant to come for a check-up or treatment. This study aims to evaluate the comprehensive approach from the upstream to downstream and culture based in dealing with HIV-AIDS in the form of Mobile Voluntary Counseling Testing (VCT) that has been carried out by the Indonesian Planned Parenthood Association (IPPA) Bali, Indonesia.

Methods: This descriptive cross sectional study was conducted in the 2016-2018 period in all regions of Bali, Indonesia, by convenience sampling technique. There are differences in the total number of services that have been performed which include Post-Test (+) counselling, Post-Test Counseling (-), rapid test evaluation, HIV counselling and prevention measures, as well as VCT Pre-Test counselling. The medical team and counsellor came together to meet directly with groups at risk of HIV-AIDS infection called key populations, such as commercial sex workers, transvestites, drug users, and homosexuals. The data obtained were analyzed descriptively using Microsoft Excel for Windows.

Results: The results of this descriptive empirical study show that the overall Post-Test (+) counselling was conducted 9 times in 2016 (2 times), 2017 (3 times), and 2018 (4 times). Whereas in Post-Test (-) counselling there were 161 examinations in 2016, 105 times (2017), and 125 (2018). In the last 3 years, 1,472 investigations have been carried out, of which 652 times were in 2016, 367 times in 2017, and 453 times in 2018.

Conclusion: Mobile VCT of IPPA Bali may be one of the effective efforts in responding to the challenges of people who tend to be taboo and less concerned about sexual and reproductive health issues. 

Latar Belakang: Saat ini penularan HIV-AIDS sebagian besar disebabkan oleh aktivitas seksual yang berisiko dan ditemukan pada kelompok heteroseksual sekitar 76,5%. Tingginya angka tersebut mungkin disebabkan oleh stigma dan diskriminasi di masyarakat, sehingga orang yang berisiko enggan datang untuk melakukan pemeriksaan atau perawatan. Penelitian ini bertujuan untuk mengevaluasi pendekatan komprehensif dari hulu ke hilir dan budaya berbasis dalam berurusan dengan HIV-AIDS dalam bentuk Pengujian Konseling Sukarela Seluler (VCT) yang telah dilakukan oleh PKBI Bali, Indonesia.

Metode: Penelitian deskriptif dengan pendekatan potong lintang ini dilakukan dalam rentang periode 2016-2018 di seluruh daerah Bali, Indonesia dengan menggunakan teknik convenience sampling. Terdapat perbedaan jumlah total layanan yang telah dilakukan dimana meliputi konseling Post-Test (+), Konseling Post-Test (-), evaluasi rapid test, konseling HIV dan tindakan pencegahan, maupun konseling VCT Pre-Test. Tim medis dan konselor datang bersama untuk bertemu langsung dengan kelompok yang berisiko terinfeksi HIV-AIDS yang disebut populasi kunci, seperti pekerja seks komersial, waria, pengguna narkoba, dan homoseksual. Data yang diperoleh dianalisis secara deskriptif menggunakan Microsoft Excel untuk Windows.

Hasil: Hasil studi empiris deskriptif ini menunjukkan bahwa telah dilakukan 9 kali konseling Post-Test (+) baik pada tahun 2016 (2 kali), 2017 (3 kali), dan 2018 (4 kali). Sedangkan pada konseling Post-Test (-) terdapat 161 kali pemeriksaan pada tahun 2016, 105 kali (2017), dan 125 (2018). Secara keseluruhan dalam 3 tahun terakhir telah dilakukan sebanyak 1.472 pemeriksaan dimana sebanyak 652 kali pada tahun 2016, 367 kali pada tahun 2017, dan 453 kali pada tahun 2018.

Kesimpulan: Mobile VCT PKBI Bali dapat menjadi salah satu upaya efektif dalam menanggapi tantangan orang-orang yang cenderung tabu dan kurang peduli tentang masalah kesehatan seksual dan reproduksi.

Hubungan antara platelet lymphocyte ratio (PLR) dengan subtipe kanker payudara pada pasien kanker payudara di Rumah Sakit Umum Pusat Sanglah, Denpasar

Background: Breast cancer is one of the most diagnosed malignancies, as well as the leading cause of cancer mortality in women worldwide. The research objective was to analyze the relationship between PLR and breast cancer subtypes in breast cancer patients in Bali.
Methods: This study used a cross sectional design to assess how PLR could predict cancer subtypes in breast cancer patients involving 52 respondents by consecutive sampling.
Result: age ? 51 years is the most respondents, 69.7% with p-value 0.218. The location of the left breast tumor was found to be more than 63.2% with a p-value of 0.416. The best cut-off point lies at 162.1. PLR ? 162.1 with the luminal subtype of breast cancer, there were 22 respondents 66.7% with an OR of 4.3 (CI: 1.29-14.50) and a p-value of 0.015. The results of logistic regression analysis showed that PLR is the dominant factor causing the luminal subtype of breast cancer.
Conclusion: Age and location of the tumor were not associated with breast cancer subtypes. PLR was significantly positive, and the strength of the association was moderate with the non-luminal subtype of breast cancer. PLR values tended to be higher in non-luminal cancer subtypes compared to luminal cancer subtypes. PLR has a dominant effect on the age and location of the tumor on the non-luminal subtype of breast cancer.

Latar Belakang: Kanker payudara adalah salah satu keganasan yang paling banyak didiagnosis, serta penyebab mortalitas akibat kanker terbanyak pada wanita di seluruh dunia. Tujuan penelitian untuk menganalisis hubungan PLR dengan subtipe kanker payudara pada penderita kanker payudara di bali.

Metode: Penelitian ini menggunakan rancangan cross sectional untuk menilai bagaimana PLR dapat memprediksi subtipe kanker pada pasien kanker payudara yang melibatkan 52 responden secara consecutive sampling.
Hasil: umur ? 51 tahun merupakan responden terbanyak (69,7%) dengan p-value 0,218. lokasi tumor mammae kiri didapatkan lebih banyak (63,2%) dengan p-value 0,416. Cutt off point terbaik terletak pada angka 162,1. PLR ? 162,1 dengan subtipe luminal kanker payudara didapatkan sebanyak 22 responden (66,7%) dengan OR 4,3 (IK: 1,29-14,50) dan p-value 0,015. Hasil analisis regresi logistik didapatkan PLR merupakan faktor dominan yang menyebabkan subtipe luminal kanker payudara.
Kesimpulan: Umur dan lokasi tumor tidak berhubungan dengan subtipe kanker payudara. PLR berhubungan positif secara signifikan dan kekuatan hubungan moderate dengan subtipe non luminal kanker payudara. Nilai PLR cenderung tinggi didapatkan pada subtipe kanker non luminal dibandingkan dengan subtipe kanker luminal. PLR mempunyai pengaruh dominan dibandingkan dengan umur dan lokasi tumor terhadap subtipe non luminal kanker payudara.

Hubungan antara Neutrophil-Lymphocyte Ratio (NLR) dengan Tumor-Infiltrating Lymphocyte (TIL), staging, dan grading histopatologi pasien kanker kolorektal di RSUP Sanglah, Bali, Indonesia

Background: Colorectal Cancer (CRC) is a significant public health problem in Indonesia. Inflammation is said to have an essential role in the pathogenesis and progressiveness of the CRC. The ratio of neutrophils and lymphocytes (NLR) is a marker that is easily measured. It is hoped that this ratio can be a useful, inexpensive, and fast marker that is routinely carried out, especially for CRC patients.

Methods: This study was an analytic cross-sectional design study to determine the relationship between NLR and TIL, histopathology, and TNM stage in patients with TRC. The variables assessed in this study included age, gender, NLR, TIL, grading, stage, and Receiver Operating Curve (ROC) analysis of the relationship between NLR and colorectal cancer stage. Data were analyzed using SPSS version 17 for Windows.

Results: There was no significant correlation (p=0.301) between NLR and TIL. The correlation of NLR with histopathological grading was also not significant (p=0.250). There was a significant correlation between NLR with the CRC staging (p<0.001). NLR's cut-off point for staging was determined to be 4.0 with a sensitivity of 98% and a specificity of 95%. This correlation has an Odd-Ratio (OR) of 465.500 and p<0.001 so that the correlation is significant. Obtained correlation coefficient (r) NLR with CRC patient stage of 0.898, where this value has a strong correlation (r> 0.75).

Conclusion: High NLR is associated with advanced stage in CRC with an NLR cut-off point of 4.

Latar Belakang: Kanker kolorektal (KKR) merupakan masalah kesehatan masyarakat di Indonesia.  Inflamasi dikatakan memiliki peran penting dalam patogenesis dan progesifitas KKR. Rasio neutrofil dan limfosit (NLR) merupakan suatu marker yang mudah diukur. Diharapkan rasio ini dapat menjadi salah satu marker yang bermanfaat, murah dan cepat serta rutin dilakukan khususnya pada pasien KKR

Metode: Penelitian ini merupakan suatu penelitian rancangan potong lintang analitik untuk mengetahui hubungan antara NLR dengan TIL, histopatologi, dan stadium TNM pada pasien dengan KKR. Variabel yang dinilai pada penelitian ini meliputi Usia, jenis kelamin, NLR, TIL, grading, stadium, maupun analisis Receiver Operating Curve (ROC) hubungan NLR dengan stadium kanker kolorektal. Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Tidak didapatkan hubungan yang bermakna (p=0,301) antara NLR dengan TIL. Hubungan NLR dengan grading histopatologi juga tidak bermakna (p=0,250). Terdapat hubungan yang bermakna antara NLR dengan stadium KKR (p<0.001). Cut-off point NLR terhadap stadium ditentukan sebesar 4.0 dengan sensitivitas 98% dan spesifisitas 95%.  Hubungan ini memiliki Odd-Ratio sebesar 465.500 dan p < 0.001 sehingga hubungannya bermakna. Didapatkan koefisien korelasi (r) NLR dengan stadium pasien KKR sebesar 0.898 dimana nilai ini memiliki korelasi yang kuat (r > 0.75).

Kesimpulan: NLR tinggi berhubungan dengan stadium yang tinggi pada kasus KKR dengan nilai cut off point NLR adalah 4. 

Hubungan berat badan lahir rendah dengan asfiksia neonatorum di Rumah Sakit Umum (RSU) Negara

Background: low birth weight is one of the mortality causes in neonates. This condition is associated with organ immaturity including lung and inadequate surfactant in alveolus which increase the risk of asphyxia neonatorum.The aim of this study is to know the correlation between low birth weight and asphyxia neonatorum in RSU Negara.

Methods: The design of this study was observational analytic cross-sectional. Neonates, who were hospitalized in NICU and perinatology RSU Negara, Jembrana in August 2019-August 2020 were assigned by systematic random sampling. Data was collected from medical records. Then, data was analyzed using chi-square test and logistic regression test to get prevalence ratio (PR). The value of p<0.05 was considered significant.

Result: As many as 150 neonates were recruited in the study. A multivariate analysis showed the prevalence of asphyxia neonatorum was significantly higher in low birth weight neonates (PR=2.331, p=0.045; IK 95% 1.018-5.338) than non-low birth weight neonates. There were no association between asphyxia neonatorum and prematurity, mode of delivery and sex of newborn.

Conclusion: low birth weight is associated with asphyxia neonatorum.

Latar Belakang: Berat badan lahir rendah merupakan salah satu penyebab kematian neonatus. Kondisi ini disertai dengan imaturitas organ tubuh termasuk paru-paru dan kurangnya surfaktan dalam alveolus sehingga meningkatkan risiko terjadinya asfiksia neonatorum. Tujuan penelitian ini adalah untuk mengetahui hubungan antara berat badan lahir rendah dan asfiksia neonatorum di RSU Negara.

Metode: penelitian ini menggunakan rancangan analitik observasional potong-lintang. Neonatus yang dirawat di Bagian NICU dan perinatologi RSU Negara, Jembrana dalam kurun waktu Agustus 2019 – Agustus 2020 yang dikumpulkan secara systematic random sampling. Data dikumpulkan dari rekam medis. Data kemudian dianalisis secara bivariat dengan uji chi-square dan multivariat dengan uji regresi logistik sehingga diperoleh prevalence ratio (PR). Hubungan dikatakan signifikan apabila diperoleh nilai p< 0,05.

Hasil: penelitian ini mengikutsertakan sebanyak 150 neonatus. Berdasarkan hasil uji multivariat, prevalensi kejadian asfiksia neonatorum lebih tinggi pada neonatus dengan BBLR (PR=2,331, p=0,045; IK 95% 1,018-5,338) dibandingkan dengan yang tidak mengalami BBLR. Tidak ada perbedaan kejadian asfiksia berdasarkan prematuritas, cara persalinan, dan jenis kelamin bayi.

Simpulan: berat badan lahir rendah berhubungan dengan asfiksia neonatorum

Manifestasi klinis dan penanganan demam berdarah dengue grade 1: sebuah tinjauan pustaka

Introduction: Dengue Hemorrhagic Fever (DHF) is a disease caused by the Dengue virus from the Flavivirus genus, Flaviviridae family, with four serotypes (DEN-1. DEN-2, DEN-3, and DEN-4). Primary dengue fever Grade 1 should receive serious attention by monitoring the patient's clinical manifestations so that patients get the right therapy immediately. If it is not treated quickly and adequately, the patient can experience an emergency with signs of shock and cause death.

Method: The writing methodology used is a literature review. The literature source consists of relevant journals and books from the search engines PubMed, Google Scholar, and Proquest.

Results: Dengue virus infection can be asymptomatic and symptomatic. Symptomatic dengue virus infection generally has a clinical spectrum grouped into 3, namely undifferentiated fever, dengue fever, and dengue hemorrhagic fever. Dengue fever (DD) patients who have no comorbidities and social indications can be treated as outpatients. Patients are given symptomatic treatment in the form of antipyretics such as paracetamol at a dose of 10-15 mg/kg/body weight, repeated 4-6 hours if fever. The management of dengue hemorrhagic fever (DHF) is symptomatic and supportive. Supportive therapy in the form of fluid replacement, which is the main point in managing DHF.

Conclusion: In patients with dengue hemorrhagic fever grade I, close monitoring is needed regarding their clinical condition. This is because grade 1 dengue has the potential to be a more critical clinical condition. Early treatment will determine a better outcome.

 

 

Pendahuluan: Demam Berdarah (DB) disebabkan oleh vírus Dengue (genus Flavivirus), dengan empat serotipe utama, yaitu DEN1. DEN2, DEN3 dan DEN4. Penyakit DB utamannya Demam berdarah dengue (DBD) Grade 1 harus mendapat perhatian serius, salah satunya dengan melakukan monitoring manifestasi klinis pasien agar pasien mendapatkan terapi yang tepat dengan segera. Apabila tidak diatasi dengan tepat dan cepat pasien dapat mengalami kegawatan dengan tanda-tanda syok dan dapat menyebabkan kematian. Tinjauan Pustaka ini bertujuan untuk memberikan informasi terbaru mengenai tanda-tanda klinis DBD grade 1 agar praktisi dapat memberikan penanganan terbaik sebelum jatuh pada kondisi kritis

Metode: Dalam penulisan ini digunakan metode tinjauan pustaka. Sumber bacaan berasal jurnal-jurnal dan buku-buku yang relevan dan sesuai dari PubMed dan Google Scholar.

Hasil: Manifestai klinis DB dapat tidak bergejala (asimtomatik) dan bergejala simtomatik. Pasien dengan gejala dengue secara umum memiliki tiga jenis spektrum klinis yaitu demam yang tidak terdiferensiasi, demam dengue, dan demam berdarah dengue.. Pasien demam dengue (DD) yang tidak memiliki komorbiditas dan indikasi sosial dapat diperlakukan sebagai pasien rawat jalan. Pasien diberikan pengobatan simptomatik berupa anitpiretik seperti parasetamol dengan dosis 10-15 mg/kg/BB/dosis, diulang 4-6 jam bila demam. Tatalaksana demam berdarah dengue (DBD) diberikan secara simtomatis (sesuai gejala) dan suportif. Penanganan suportif dapat diberikan berupa cairan tambahan yang merupakan poin utama dalam penatatalaksanaan DBD.

Kesimpulan: Pada pasien demam berdarah dengue derajat I diperlukan pemantauan yang ketat terkait kondisi klinis pasien. Hal ini dikarenakan DBD grade 1 berpontensi menjadi kondisi klinis yang lebih kritis. Penanganan dini akan menentukan outcome yang lebih baik.

Sistem skoring hematologi Rodwell sebagai metode diagnosis awal sepsis neonatorum di Rumah Sakit dengan fasilitas terbatas: sebuah tinjauan sistematis

Background: Neonatal sepsis is a major cause of morbidity and mortality in neonates with an incidence in Indonesia at about 8.7 to 30.29%. Blood culture as the gold standard for diagnosis is not available in all health care centers. An easy, fast and inexpensive diagnostic method is needed to overcome these problems. The diagnostic method that can be used is the Rodwell hematology scoring system (HSS). It uses seven hematologic parameters obtained through a complete blood count and peripheral blood smears examination. This systematic review aims to evaluate Rodwell HSS as a method for early diagnosis of neonatal sepsis in hospitals with limited facilities.

Methods: A systematic review of literature searching through the Cochrane Library, PubMed, and Google Scholar journal database was done by two reviewers. The inclusion criteria were studied about the diagnostic method for neonate's sepsis using Rodwell HSS and compared neonate's sepsis diagnostic method between Rodwell HSS and blood culture. The exclusion criteria were studies that were not published in English or Bahasa, not available in full text, and study with a case report, systematic review, or meta-analysis design.

Result: The hematological scoring system has the same sensitivity as its specificity. Sensitivity range is 80-100%, specificity 60.3-90%, PPV 26-73% and NPV 92.1-100%. A score of > 4 has an AUC value of 90.2%, which shows that this diagnostic test's accuracy is excellent.

Conclusion: The hematological scoring system with a score of > 4 gives the most rational and reliable results for the early diagnosis of neonatal sepsis. Due to its high sensitivity, specificity, and using simple examination, making these criteria suitable to use as a method for early diagnosis of neonatal sepsis, especially in limited health facilities hospital.

Latar belakang: Sepsis neonatorum merupakan penyebab utama morbiditas dan mortalitas pada neonatus dengan angka prevalensi di Indonesia 8,7 hingga 30,29%. Pemeriksaan baku emas untuk penegakkan diagnosis yaitu kultur darah, tidak tersedia di seluruh sentra layanan kesehatan. Sebuah metode diagnostik yang mudah, cepat dan murah diperlukan untuk mengatasi permasalahan tersebut yakni dengan sistem skoring hematologi (SSH) Rodwell. Tujuan tinjauan sistematis ini adalah mengevaluasi peran SSH Rodwell sebagai metode diagnosis dini sepsis neonatorum di rumah sakit dengan fasilitas terbatas.

Metode: Tinjauan sistematis berupa penelusuran literatur dilakukan oleh dua orang peneliti melalui database jurnal Cochrane Library, PubMed dan Google Scholar menggunakan operator Boolean. Kriteria inklusinya adalah studi mengenai metode diagnosis sepsis pada neonatus menggunakan SSH Rodwell dan membandingkan antara SSH Rodwell dengan kultur darah. Sedangkan kriteria eksklusinya studi yang terpublikasi tidak dalam bahasa Inggris atau Indonesia, tidak tersedia secara full-text dan desain studi berupa laporan kasus, tinjauan sistematis atau meta analisis.

Hasil: SSH Rodwell memiliki sensitivitas yang sama baiknya dengan spesifitasnya. Sensitivitas berada dalam rentang 80-100%, spesifisitas 60,3-90%, PPV 26-73% dan NPV 92,1-100%. Skor >4 memberikan nilai AUC 90,2% menunjukkan akurasi test diagnostik ini sangat baik.

Kesimpulan. SSH Rodwell dengan skor >4 memberikan hasil yang paling rasional dan reliabel untuk diagnosis awal sepsis pada neonatus. Penggunaan parameter yang sederhana menjadikan pemeriksaan ini cocok diaplikasikan pada rumah sakit dengan fasilitas kesehatan terbatas.

Koagulopati pada Coronavirus Disease-2019 (COVID-19): Tinjauan pustaka

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 has spread globally and become a new pandemic. Although the clinical manifestation of COVID-19 mainly affected the respiratory system, coagulopathy often occurs in the severe cases and is associated with increased mortality. This literature review aims to provide a review of coagulopathy in COVID-19.

Methods: This literature review involved 52 relevant literature about coagulopathy and COVID-19. Different data sources or manual literature search methods used to find articles related to the topic of literature.

Results: COVID-19 can trigger cytokine storms and systemic hyperinflammation which cause increased activation of coagulation and resulting in hypercoagulability. Hypercoagulability state in COVID-19 increases the risk of thrombosis and thromboembolism, particularly venous thromboembolism. Prophylactic anticoagulants can prevent thromboembolic events and improve the prognosis of COVID-19 patients with coagulopathy.

Conclusion: The hypercoagulation state in COVID-19 can increase the risk of complications from thrombosis and thromboembolism, especially venous thromboembolism. Increased D-dimers are a marker of coagulopathy that is often found in patients with severe COVID-19 and is associated with disease severity.

Latar Belakang: Coronavirus disease 2019 (COVID-19) merupakan penyakit infeksi akibat severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 telah menyebar secara global dan menjadi pandemi baru. Walaupun manifestasi klinis COVID-19 terutama mengenai sistem respirasi, koagulopati seringkali terjadi pada kasus berat dan berhubungan dengan peningkatan mortalitas. Tinjauan pustaka ini bertujuan untuk memberikan ulasan mengenai koagulopati pada COVID-19.

Metode: Tinjauan pustaka ini melibatkan 52 literatur yang relevan tentang koagulopati dan COVID-19. Sumber data yang berbeda atau metode pencarian literatur manual digunakan untuk mencari artikel yang berkaitan dengan topik literatur.

Hasil: COVID-19 dapat memicu terjadinya badai sitokin dan hiperinflamasi sistemik yang menyebabkan terjadinya peningkatan aktivasi koagulasi dan mengakibatkan hiperkoagulasi. Keadaan hiperkoagulasi pada COVID-19 meningkatkan risiko terjadinya trombosis dan tromboemboli, terutama tromboemboli vena. Antikoagulan profilaksis dapat mencegah kejadian tromboemboli dan meningkatkan prognosis pada pasien COVID-19 dengan koagulopati.

Kesimpulan: Keadaan hiperkoagulasi pada COVID-19 dapat meningkatkan risiko terjadinya komplikasi trombosis dan tromboemboli, terutama tromboemboli vena. Peningkatan D-dimer merupakan penanda koagulopati yang sering ditemukan pada pasien COVID-19 berat dan berhubungan dengan keparahan penyakit.

Comparison between negative pressure and conventional wound dressing for diabetic foot ulcer: A systematic review

Background: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus (DM), resulting in loss of limb or life. Negative pressure wound therapy (NPWT) is an emerging therapeutic option in the management of DFU. This study aims to compare the efficacy of NPWT to conventional moist wound dressing in the management of DFU.

Methods: Literature was searched from online public scientific databases, including PubMed, Google Scholar, ScienceDirect, and Portal Garuda. Our review included clinical trials and analytic studies comparing NPWT and conventional moist dressing to treat DFU published in 2017 or later. Outcome measures include the proportion of wound healing, healing time, ulcer size reduction, granulation time, amputation, infection, and bleeding.

Results: We include 11 articles, including eight randomized clinical trials (RCTs), two retrospective analytic studies, and one non-random clinical trial. There was methodological variation between studies on the application of NPWT, outcome measures reported, and length of follow up. Results mostly showed NPWT yielded a higher proportion of complete wound healing, shorter healing time, granulation time, and faster ulcer size reduction rate. However, NPWT was not associated with a reduction of amputation risks.

Conclusions: Our review found NPWT was superior in short-term treatment outcomes such as granulation time and wound closure; however, there was no difference in reducing amputation risk between NPWT and conventional moist dressing. Results are inconclusive due to variation in methodologies of included articles.

A case of secondary syphilis with stage four HIV infection accompanied with tuberculous lymphadenitis in bisexual man

Introduction: Sexually transmitted infections (STIs) is still a major health issue nowadays. Several studies have shown an increased incidence of STIs in the group of man who has sex with man (MSM) and bisexuals when compared to heterosexual men or women. This is inseparable from risky sexual behaviour practiced by this population, so it is not impossible for individual in this population to be suffering from more than one STI.

Case description: We report one case of secondary syphilis with fourth stage HIV infection accompanied with tuberculous lymphadenitis in a bisexual man.

Conclusion: Management of each specific condition have to in accordance with treatment standards guideline. Long term evaluation regarding patient compliance, laboratory serology test, and further education regarding the disease and transmission are mandatory.

Exogenous Rinolith: a case report

Background: Rhinolith results from mineralized nasal foreign bodies. The time required for rhinolith formation is around 15 years and is usually diagnosed in the third decade of life. Most rhinoliths are asymptomatic or present with unspecific minimal symptoms. Symptoms of rhinolith include unilateral or bilateral foul nasal discharge, epistaxis, nasal obstruction, and halitosis. This case study aims to evaluate the recent management of exogenous rhinolith.

Case Presentation: We present a case of unilateral rhinolith in an 11 years old boy with a history of inserting eraser fragment into the left nostril at the age of 5. The patient complained of recurrent epistaxis with foul nasal discharge from the left nasal cavity. Rhinolith was extracted under general anesthesia. The extraction performed using raspatorium and headlight. The rhinolith was firmly attached to the floor of the nasal cavity but can be removed in toto. The specimen was sent to the Pathology Department for histopathological examination. The result showed respiratory epithelium covering edematous stroma with a proliferative vessel and lymphoplasmacytic inflammatory cell infiltration

Conclusion: Rhinolith is a rare condition with no or minimal symptoms. Management of rhinolith is extraction that can be performed under local or general anesthesia.

Staphylococcus aureus sebagai agen penyebab infeksi pada kasus erisipelas kruris dekstra dengan liken simpleks kronikus

Background: Erysipelas is a skin and soft tissue infection that affects the epidermis and superficial dermis as well as superficial lymphatic vessels. Erysipelas can occur due to the entry of bacteria through the skin barrier that is not intact and can occur in other medical conditions such as in patients with lichen simplex chronicus.

Case presentation: A man, aged 62, Javanese, came to the Sanglah Hospital Emergency Room because of swelling, redness, and pain in the right calf since 2 days ago and complained of itching in the right lower leg since 1 week ago. The patient has a 1-year history of lichen simplex chronicus and has received medication. Physical examination found the presence of erythema patch efflorescence, warm palpation of the touch, non-pitting edema, pain on pressure, and diascopy test of blanching on pressure. The results of the wound bed culture examination showed the isolation of S. aureus. Intravenous fluids, open compresses, antibiotics, pain relievers, and anti-inflammatory creams were given to patients who experienced improvement on day 8.

Discussion: The diagnosis of erysipelas is determined from the patient's complaints and the clinical picture from the results of the physical examination. In erysipelas, microbial pathogens enter through skin damage, then spread locally and systemically. Antibiotics have become the standard in the management of erysipelas by bacterial infections. The administration of ceftriaxone antibiotics was carried out based on the results of the sensitivity test also obtained on the results of the isolation of sensitive S. aureus bacteria.

Conclusion: Diagnosis of erysipelas is based on history, physical examination, and investigation. Management of patients includes open compresses, administration of fluids, antibiotics, pain relief, and use of anti-inflammatory creams.